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      Neuropsychiatric Disease and Treatment (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on all aspects of neuropsychiatric and neurological disorders. Sign up for email alerts here.

      63,741 Monthly downloads/views I 2.989 Impact Factor I 4.5 CiteScore I 1.09 Source Normalized Impact per Paper (SNIP) I 0.744 Scimago Journal & Country Rank (SJR)

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      Bupropion SR in adults with ADHD: a short-term, placebo-controlled trial

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          Abstract

          Increased attention has been given to the alternatives to stimulants in the treatment of attention deficit hyperactivity disorder (ADHD) in both adults and children. This short-term, double-blind trial was designed to evaluate the extended-release form of bupropion in adult subjects meeting DSM-IV and the Utah Diagnostic Criteria for ADHD. Outcome measures were the Clinical Global Impressions-Improvement (CGI-I) and the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS), which assesses adult ADHD symptoms. Outcome (defined by the CGI-I, average WRAADDS scores, or a 50% improvement on the WRAADDS) favored bupropion SR over placebo, but achieved statistical significance on only one, post hoc measure. Other measures showed trends for improvement with bupropion. Given the small size of this study, these findings deserve further exploration.

          Most cited references32

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          Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies.

          David Michelson, Lenard Adler, Thomas R. Spencer … (2003)
          [corrected] Attention-deficit/hyperactivity disorder (ADHD) has been less studied in adults than in children, and the treatment studies reported to date have been small, single-center trials. To assess the efficacy of atomoxetine, a new and highly selective inhibitor of the norepinephrine transporter, we conducted two large, multicenter treatment trials. Two identical studies using randomized, double-blind, placebo-controlled designs and a 10-week treatment period were conducted in adults with DSM-IV-defined ADHD as assessed by clinical history and confirmed by a structured interview (study I, n = 280; study II, n = 256). The primary outcome measure was a comparison of atomoxetine and placebo using repeated measures mixed model analysis of postbaseline values of the Conners' Adult ADHD Rating Scale. In each study, atomoxetine was statistically superior to placebo in reducing both inattentive and hyperactive and impulsive symptoms as assessed by primary and secondary measures. Discontinuations for adverse events among atomoxetine patients were under 10% in both studies. Atomoxetine appears to be an efficacious treatment for adult ADHD. Its lack of abuse potential may be an advantage for many patients.
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            Bupropion: a review of its mechanism of antidepressant activity.

            Virginia Ferris, Didier J. Colin, Tamara Martin … (1995)
            The mechanism of action of the novel antidepressant bupropion remains unclear after many years of study. A review of the relevant biochemical, in vivo brain microdialysis, electrophysiologic, behavioral, and clinical data clarifies what is known about this unique compound and suggests possible modes of action. A panel of 11 experts was convened for a conference to discuss bupropion's mechanism of antidepressant activity. Four of the panelists presented current research findings, followed by a discussion. (1) Biochemical studies suggest down-regulation of postsynaptic beta-adrenoceptors and desensitization of the norepinephrine-stimulated adenylate cyclase in the rat cortex occur only after chronic administration of very high doses of bupropion. (2) In vivo brain microdialysis studies demonstrate that, after chronic administration, there is an enhancement of bupropion-induced increases in extracellular dopamine in the nucleus accumbens. (3) Electrophysiologic data show that with acute dosing, bupropion reduces the firing rates of noradrenergic neurons in the locus ceruleus. The firing rates of dopaminergic neurons are reduced by bupropion in the A9 and A10 areas of the brain, but only at very high doses, and bupropion does not alter the firing rates of serotonergic neurons in the dorsal raphe. (4) Behavioral studies show that the most active metabolite of bupropion, hydroxybupropion (306U73), appears to be responsible for a large part of the compound's effects in animal models of antidepressant activity. (5) Clinical studies indicate that bupropion enhances noradrenergic functional activity as reflected by an increased excretion of the hydroxy metabolite of melatonin, while at the same time producing a presumably compensatory decrease in norepinephrine turnover. In one study, bupropion elevated plasma levels of the dopamine metabolite homovanillic acid in nonresponders, but not in responders. The mechanism of action of bupropion appears to have an unusual, not fully understood, noradrenergic link. The bupropion metabolite hydroxybupropion probably plays a critical role in bupropion's antidepressant activity, which appears to be predominantly associated with long-term noradrenergic effects. The mild central nervous system activating effects of bupropion appear to be due to weak dopaminergic mechanisms. There is some evidence that dopamine may contribute to bupropion's antidepressant properties. Antidepressant effects of bupropion are not serotonergically mediated.
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              Effectiveness and tolerability of tomoxetine in adults with attention deficit hyperactivity disorder.

              T Wilens, Kirk T Spencer, Grant Hatch … (1998)
              The authors assessed the experimental noradrenergic compound tomoxetine as an alternative treatment for adult attention deficit hyperactivity disorder (ADHD). They conducted a double-blind, placebo-controlled, crossover study of tomoxetine in 22 adults with well-characterized ADHD. Treatment with tomoxetine at an average oral dose of 76 mg/day was well tolerated. Drug-specific improvement in ADHD symptom was highly significant overall and sufficiently robust to be detectable in a parallel-groups comparison restricted to the first 3 weeks of the protocol. Eleven of 21 patients showed improvement after receiving tomoxetine, compared with only two of 21 patients who improved after receiving placebo. Significant tomoxetine-associated improvement was noted on neuropsychological measures of inhibitory capacity from Stroop tests. This preliminary study showed that tomoxetine was effective in treating adult ADHD and was well tolerated. These promising results provide support for further studies of tomoxetine over an extended period of treatment.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Neuropsychiatr Dis Treat
                Journal ID (publisher-id): Neuropsychiatric Disease and Treatment
                Title: Neuropsychiatric Disease and Treatment
                Publisher: Dove Medical Press
                ISSN (Print): 1176-6328
                ISSN (Electronic): 1178-2021
                Publication date (Print): September 2005
                Volume: 1
                Issue: 3
                Pages: 245-251
                Affiliations
                [1 ]University of Utah, Department of Psychiatry Salt Lake City, UT, USA
                Author notes
                Correspondence: Frederick W Reimherr Mood Disorders Clinic, Department of Psychiatry, University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, UT 84123, USA Tel +1 801 581 5088 Fax +1 801 585 7830 Email fred.reimherr@ 123456hsc.utah.edu
                [2]

                Present address: Department of Psychology, Brigham Young University, Provo, UT, USA

                Article
                PMC ID: 2416755
                PubMed ID: 18568102
                SO-VID: 1d284e84-eb4f-45f9-8ff9-41d83aaa65cf
                Copyright © © 2005 Dove Medical Press Limited. All rights reserved
                History
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Neurology
                Keywords: controlled study,adult,adhd,bupropion sr
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: controlled study, adult, adhd, bupropion sr

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